Provider Demographics
NPI:1053814509
Name:HANMAUM SENIOR CARE LLC
Entity Type:Organization
Organization Name:HANMAUM SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEUM
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-770-0409
Mailing Address - Street 1:4606 MCEVER RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2610
Mailing Address - Country:US
Mailing Address - Phone:678-770-0409
Mailing Address - Fax:770-538-0734
Practice Address - Street 1:4606 MCEVER RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2610
Practice Address - Country:US
Practice Address - Phone:678-770-0409
Practice Address - Fax:770-538-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH009770310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCH009770OtherPERSONAL CARE HOME PERMIT